脑白质病变与老年首次短暂性脑缺血/轻型卒中患者认知功能障碍的研究

Relationship between white matter hyperintensity and cognitive impairment in elderly patients with initial transient cerebral ischemia/mild stroke

目的探讨老年首次短暂性脑缺血/轻型卒中患者认知功能障碍与脑白质高信号(WMHs)的关系。方法选取2015年1月至2018年12月无锡市锡山人民医院神经内科收治的,符合标准的105例老年首次短暂性脑缺血/轻型卒中患者,均行头颅MRI等检查,患者认知障碍根据蒙特利尔认知评估量表(MoCA)评分结果分为无认知障碍组、暂时性认知障碍组和持续性认知障碍组。采用单因素方差分析比较3组间年龄、美国国立卫生院卒中量表评分、MoCA评分的差异,组间差异两两比较应用q检验;采用χ2检验比较组间性别(男性)、高血压、糖尿病、高脂血症、MRI影像改变及梗死部位的差异;采用多因素Logistic回归分析老年首次短暂性脑缺血/轻型卒中患者发生认知功能障碍的危险因素。结果持续性认知障碍组患者的年龄、男性比例和WMHs比例高于无认知障碍组,差异均具有统计学意义(P<0.05);而在高血压、糖尿病、高脂血症、脑微出血、血管间隙扩大、腔隙性缺血灶、磁共振弥散加权成像(DWI)阳性病变及DWI显示脑梗死病变部位比较差异均无统计学意义(P均>0.05)。WMHs病变程度越严重,发生认知障碍的比例越高,差异具有统计学意义(P<0.05)。经校正年龄、性别、高血压、糖尿病等因素后,年龄和中-重度WMHs病变为老年首次短暂性脑缺血/轻型卒中后持续性认知功能障碍发生的独立危险因素(OR:1.08,95%CI:1.01~1.15,P=0.021;OR:1.66,95%CI:0.79~2.89,P=0.042)。结论年龄和WMHs中-重度病变为老年首次短暂性脑缺血/轻型卒中患者第90天后发生持续性认知障碍的危险因素。

Objective To investigate the correlation between cognitive impairment and white matter hyperintensity(WMH)in elderly patients with initial transient cerebral ischemia/mild stroke.Methods From January 2015 to December 2018,a total of 105 elderly patients with initial transient cerebral ischemia/mild stroke who met the criteria at the Department of Neurology,Xishan People's Hospital of Wuxi were enrolled in this study.All patients underwent cranial MRI and other examinations.The patients was divided into a non-cognitive impairment group,temporary cognitive impairment group,and persistent cognitive impairment group according to MoCA scale score.The differences in age,NIHSS score,and MOCA score among the three groups were compared by one-way ANOVA,and the differences between the two groups were compared by Q-test.The differences in sex(male),hypertension,diabetes,hyperlipidemia,MRI image changes,and infarct location were compared by the Chi-square test.Multivariate Logistic regression was used to analyze the risk factors for cognitive dysfunction in elderly patients with initial transient cerebral ischemia/mild stroke.Results Age and the proportions of males and those with white matter hyperintensity were significantly higher in the persistent cognitive impairment group than in the non-cognitive impairment(P<0.05),while hypertension,diabetes mellitus,hyperlipidemia,cerebral microhemorrhage,enlargement of vascular space,lacunar ischemia,acute cerebral infarction,and location of cerebral infarction lesion showed by DWI had no statistical differences(P>0.05).Patients with more severe WMH lesions were significantly more likely to develop cognitive impairment(P<0.05).After adjusting for age,sex,hypertension,diabetes,and other factors,age(OR=1.08,95%CI:1.01-1.15,P=0.021)and moderate-to-severe WMH lesions(OR=1.66,95%CI:0.79-2.89,P=0.042)were significantly associated with the development of persistent cognitive dysfunction after initial transient cerebral ischemia/mild stroke in the elderly patients(P<0.05).Conclusion Age and moderate-to-severe WMH lesions are risk factors for persistent cognitive impairment in elderly patients with initial transient cerebral ischemia/mild stroke.